Individual provider Active NPI

Kyle Handrich

  • Mental Health Counselor
  • Grand Rapids, MI
National Provider Identifier
1205554615
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
4867 E Beltline Ave NE Ste 400
Grand Rapids, MI 49525-9787
Phone
(989) 745-9133
NPI assigned
Aug 22, 2022
Last updated
Oct 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

4867 E Beltline Ave NE Ste 400
Grand Rapids, MI 49525-9787

Mailing address

1510 Derby Dr NW
Grand Rapids, MI 49504-2678

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241106003765 MI Practitioner - Mental Health Counselor 5395279830 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Peripheral Counseling LLC Counselor CurrentSince Oct 27, 2024 Accepting new patients

Locations

1971 E Beltline Ave NE
Ste 200E
Grand Rapids, MI 49525
Phone (989) 745-1933

4867 E Beltline Ave NE
Bldg 1
Grand Rapids, MI 49525
Phone (606) 340-6417

4867 E Beltline Ave NE
Ste 400
Grand Rapids, MI 49525
Phone (616) 287-0545

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1205554615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 DERBY DR NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495042678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4867 E BELTLINE AVE NE STE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259787",
            "telephone_number": "989-745-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANDRICH",
        "first_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-22",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.